The use of the .beta.-lactam antibiotic cephaloridine in man is associated with a significant incidence of nephrotoxicity. The nephrotoxic potential of this and other antibiotics can be duplicated in laboratory studies in the rabbit wherein single large doses of the antibiotic are found to produce within 48 hours an elevation of the level in blood of nitrogenous substances normally excreted by the kidney. Subsequent microscopic examination of the kidneys reveals renal tubular epithelial necrosis. In this laboratory model, the new .beta.-lactam antibiotic N-formimidoyl thienamycin has also been shown nephrotoxic at dose rates comparable to those used with cephaloridine. The nephrotoxic activity of both antibiotics can be prevented by co-administration of a 3-substituted propenoate of the following Formula I, below An additional group of compounds useful is described by Formula II, also below. The compounds of Formula I: ##STR1## wherein R.sup.2 and R.sup.3 are hydrocarbon radicals in the range respectively of 3-10 and 1-15 carbon atoms. In either of these hydrocarbon radicals R.sup.2 and R.sup.3, up to 6 hydrogens may be replaced by halogens, or a non-terminal methylene may be replaced by oxygen or sulfur, including oxidized forms of the latter
A terminal hydrogen in R.sup.3 can also be replaced by a hydroxyl or thiol group, which may be acylated, such as with an alkanoyl acid of 1-8 carbon atoms, or carbamoylated, including alkyl and dialkyl carbamate derivatives; or the hydrogen can be replaced by an amino group, which may be derivatized as in an acylamino, ureido, amidino, guanidino, or alkyl or substituted alkyl amino group, including quaternary nitrogen groupings; or, alternatively, there may be replacement by acid groups such as carboxylic, phosphonic or sulfonic acid groups or esters or amides thereof, as well as cyano; or combinations thereof, such as a terminal amino acid grouping.
R.sup.2 is preferably a branched alkyl or cycloalkyl radical (C.sub.3-10), with a limitation that the carbon adjacent to the carbonyl cannot be tertiary. R.sup.1 is hydrogen, loweralkyl ) or dialkylaminoalkyl (e.g., --CH.sub.2 CH.sub.2 N(C.sub.2 H.sub.5).sub.2, --CH.sub.2 CH(CH.sub.3)N(C.sub.3).sub.2.
The compounds of Formula I are not novel to this invention, but are disclosed and claimed in U.S. Ser. No. 927,212, filed July 24, 1978, and now abandoned, and its continuation-in-part application, U.S. Ser. No. 050,233, filed June 22, 1979, and now abandoned. It is presently believed that all compounds within the scope of this Formula possess the ability to prevent nephrotoxicity. One compound in particular has been shown to possess this property; this compound is Z-2-(2,2-dimethylcyclopropane carboxamido)-2-octenoic acid. Particularly preferred compounds, in addition to the latter, are the following: Z-2-(2,2-dimethylcyclopropane carboxamido)-2-butenoic acid; Z-2-(2,2-dimethylcyclopropane carboxamido)-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropane carboxamido)-2-hexenoic acid; and Z-2-(2,2-dimethylcyclopropane carboxamido)-8-trimethylammonium-2-octenoic acid.
The compounds of Formula I have previously been taught as useful as pharmaceutical compositions in combination with the thienamycins, but not with cephaloridine. The combination is disclosed and claimed in U.S. Ser. No. 927,213, filed July 24, 1978, and now abandoned, and in its continuation-in-part application, U.S. Ser. No. 050,232, filed June 22, 1979, and now abandoned.
Within the general structure of Formula I, the following sub-groups of compounds are valuable:
Within the definition of R.sup.2, the following sub-groups are included: EQU --R.sup.4 I A
wherein R.sup.4 is a straight, branched, or cyclic hydrocarbon radical of 3-10 carbon atoms which may be substituted as specified above in the definition of R.sup.2 ; EQU --R.sup.5 R.sup.6 I B
wherein R.sup.5 is cycloalkyl of 3-6 carbon atoms and R.sup.6 is either 1 or 2 alkyl substituents which may be joined to form another ring on the cycloalkyl group, or R.sup.5 and R.sup.6 may be substituted as specified above in the definition of R.sup.2 ; EQU --R.sup.7 R.sup.8 I C
wherein R.sup.7 is an alkylene group of 1-3 carbon atoms and R.sub.8 is cycloalkyl of 3-6 carbon atoms which may be substituted as specified above in the definitions of R.sup.2 and R.sup.3.
The following compounds within this Formula are included in this invention.
I A: Z-2-isovaleramido-2-pentenoic acid; methyl Z-2-isovaleramido-2-butenoate; Z-2-isovaleramido-2-butenoic acid; Z-2-benzamido-2-butenoic acid; Z-2-(3,5,5-trimethylhexanamido)-2-butenoic acid; Z-2-cyclobutanecarboxamido-2-butenoic acid; Z-2-cyclopropanecarboxamido-2-butenoic acid; Z-2-cyclopropanecarboxamido-2-pentenoic acid; Z-2-(3-methylvaleramido)-2-butenoic acid; Z-2-cycloheptanecarboxamido-2-butenoic acid; Z-2-nonanamido-2butenoic acid; Z-2-cyclohexanecarboxamido-2-butenoic acid; Z-2-(4-methylvaleramido)-2-butenoic acid; Z-2-t-butylacetamido-2-butenoic acid; Z-2-octanamido-2-butenoic acid; Z-2-butyramido-2-butenoic acid; Z-2-valeramido-2-butenoic acid; Z-2-valeramido-2-pentenoic acid; Z-2-cyclopentanecarboxamido-2-butenoic acid; Z-2-(6-methylheptanamido)-2-butenoic acid; Z-2-hexanamido-2-butenoic acid; Z-2-(3,7-dimethyloctanamido)-2-butenoic acid; Z-2-(3,7-dimethyl-6-octenamido)-2-butenoic acid; Z-2-(5-chlorovaleramido)-2-butenoic acid; Z-2-(3-chlorobenzoylamido)-2-butenoic acid; Z-2-(2-chlorobenzamido)-2-butenoic acid; Z-2-(6-bromohexanamido)-2-butenoic acid; Z-2-(3,3-dimethylpropenamido)-2-butenoic acid; Z-2-benzamido-2-cinnamic acid; Z-2-benzamido-2-pentenoic acid; Z-2-benzamido-5-methoxy-2-pentenoic acid; Z-2-benzamido-2-hexenedioic acid; Z-2-isovaleramido-2-octenoic acid; Z-2-isovaleramido-2-cinnamic acid; Z-2-isovaleramido-2-hexenedioic acid; Z-2-cyclopropanecarboxamido-2-cinnamic acid; Z-2-cyclopropanecarboxamido-2-hexenedioic acid; Z-2-(5-methoxy-3-methylvaleramido)-2-butenoic acid; Z-2-ethylthioacetamido-2-butenoic acid; Z-2-(2,2-dichlorocyclopropanecarboxamido)-2-butenoic acid; Z-2-(2-ethylhexanamido)-2-butenoic acid; Z-2-di-n-propylacetamido-2-butenoic acid; PA0 I B: Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoic acid; (+)-Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-octenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-hexenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-cinnamic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-methoxy-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-4,4,4-trifluoro-2-butenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-3-(2-chlorophenyl)propenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2hexenedioic acid; Z-2-(2-ethylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2,2-diethylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2,2-diethylcyclopropanecarboxamido)-2-pentenoic acid; Z-2-(2-isopropyl-2-methylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2-methylcyclohexanecarboxamido)-2-butenoic acid; Z-5-cyano-2-(2,2-dimethylcyclopropanecarboxamido)-2-pentenoic acid; Z-5-(N,N-dimethylcarbamoyl)-2-(2,2-dimethylcyclopropanecarboxamido)-2-pent enoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-methanesulfonyl-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-ethoxycarbonyl-2-pentenoic acid; Z-2-(2-methylcyclopropanecarboxamido)-2-butenoic acid; methyl Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoate; ethyl Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoate; 2-dimethylaminoethyl ester of Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoic acid; 3-diethylaminoproipyl ester of Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-pentenoic acid; Z-2-(2,3-dimethylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(3,3-dimethylcyclobutanecarboxamido)-2-butenoic acid; Z-2-(2-spirocyclopentanecarboxamido)-2-butenoic acid; Z-2-(2 -t-butyl-3,3-dimethylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-4-methyl-2-pentenoic acid; Z-2-(2-t-butylcyclopropanecarboxamido)-2-butenoic acid; Z-2-(2-phenylcyclopropanecarboxamido)-2-butenoic acid; Z-3-cyclohexyl-2-(2,2-dimethylcyclopropanecarboxamido)propenoic acid; Z-5-carboxy-5-(2,2-dimethylcyclopropanecarboxamido)-4-pentenamidine; Z-5-dimethyl amino-2-(2,2-dimethylcyclopropanecarboxamido)-2-pentenoic acid; Z-3-cyclopropyl-2-(2,2-dimethylcyclopropanecarboxamido)propenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2,5-hexadienoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-4-phenyl-2-butenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-6-mercapto-2-hexenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-methylthio-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-phosphono-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-heptenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-5-phenyl-2-pentenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-nonenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-decenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-2-tridecenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-6-methoxy-2-hexenoic acid; Z-2-(2,2-dimethylcyclopropanecarboxamido)-6-methyl-2-heptenoic acid; Z-4-cyclohexyl-2-(2,2-dimethylcyclopropanecarboxamido)-2-butenoic acid; PA0 I C: Z-2-cyclobutylacetamido-2-butenoic acid; Z-2-cyclopentylacetamido-2-butenoic acid; Z-2-cyclohexylacetamido-2-butenoic acid; Z-2-(4-cyclohexylbutyramido)-2-butenoic acid; Z-2-cyclopropylacetamido-2-butenoic acid; Z-2-cyclopropylacetamido-2-pentenoic acid; Z-2-(3-cyclopentylpropionamido)-2-butenoic acid; Z-2-(3-cyclohexylpropionamido)-2-butenoic acid; Z-2-(4-(2-thienyl)-butyramido)-2butenoic acid; Z-2-(4-phenylbutyramido)-2-butenoic acid; Z-2-(D,L-.alpha.-lipoamido)-2-pentenoic acid; Z-2-(D,L-.alpha.-lipoamido)-2-cinnamic acid; Z-2-(3-(2-tetrahydrofuryl)-propionamido)-2-butenoic acid.
Particularly preferred substituents within the definition of R.sup.2 above include the 2,2-dimethylcyclopropyl and the 2,2-dichlorocyclopropyl groups.
Within the definition of R.sup.3, particularly preferred groups of compounds include n-alkyl (1-9 carbons) and n-alkyl (1-9 carbons), having a terminal substituent which is a quaternary nitrogen, amine derivative, or amino acid derived group.
By the term "quaternary nitrogen" is meant a tetrasubstituted or heteroaromatic nitrogen which is positively charged. An ammonium moiety, substituted groups having 1-7 carbon atoms, which can be the same or different, is signified.
By the term "amino derivative" is meant a group such as amino, acylamino, ureido, amidino, guanidino and alkyl derivatives thereof.
By the term "amino acid derived group" is meant a moiety such as cysteinyl (--SCH.sub.2 CH(NH.sub.2)COOH) or sarcosyl (--N(CH.sub.3)CH.sub.2 COOH) in which a hydrogen joined to O, N or S of known amino acids is replaced.
Particularly preferred compounds from the most preferred groups of substituents of R.sup.2 and R are those wherein R.sup.2 is 2,2-dimethylcyclopropyl or 2,2-dichlorocyclopropyl, and R.sup.3 is a hydrocarbon chain of 1 to 3 carbon atoms without a terminal substituent, or 3 to 7 carbon atoms having a terminal substituent which is trimethylammonium, amidino, guanidino, 2-amino-2-carboxyethylthio, or ureido.
An additional group of propenoate compounds similar in structure to those of Formula I, have the following formula: ##STR2## wherein n is an integer from 3 to 5 and Y is a heterocyclic or phenyl group which may be substituted or unsubstituted. By the term heterocyclic is meant pyridyl, pyrimidinyl, tetrazolyl, imidazoyl, thiadiazolyl and the like. These rings, and the phenyl ring can be unsubstituted or substituted with hydroxyl, oxo, carboxyl, or methyl. Desirable Y groups include 2-pyridyl, 4-pyridyl, 2-pyridyl-3-hydroxyl, 2-pyridyl-3-carboxyl, 2-pyridyl-4-carboxyl, 2-carboxylphenyl, 1-methyl-1,2,3,4-tertazo-5-yl, 4-carboxy-6-hydroxy-2-pyrimidinyl, and others.
The compounds of Formula II are claimed in a copending U.S. application, U.S. Ser. No. 285,161, case 16544IA, now U.S. Pat. No. 4,406,902, Ashton et al, filed concurrently herewith.
Although these compounds of Formulas I and II, when R.sup.1 is H, are described and named as the free acids, it will be apparent to one skilled in the art that various pharmaceutically acceptable derivatives such as alkali and alkaline earth metal, ammonium, or amine salts, or the like can be employed as equivalents thereto. Salts such as the sodium, potassium, calcium, magnesium, or tetramethylammonium salts are suitable.
The benefit of the 3-substituted propenoates is best appreciated when they are co-administered with the antibiotic, to human or animals in need of antibiotic therapy.
The combination of the 3-substituted propenoate and the antibiotic can be in the form of a pharmaceutical composition containing the two compounds in a pharmaceutically acceptable carrier. The two can be employed in amounts so that the weight ratio of the antibiotic to propenoate is 1 to 0.1-3 and preferably 1 to 0.5-2.0.
The components can also be separately administered. For instance, the antibiotic can be administered intramuscularly or intravenously in amounts of 2-150 mg/kg/day, preferably 5-75 mg/kg/day, in divided dosage forms, e.g., two to four times a day. The propenoate can be separately administered, orally, intramuscularly, or IV, in amounts of 1-300 mg/kg/day, or preferably 2.5-150 mg/kg/day, The amounts of the two components administered during one day ideally are within the ratio limits denoted above.
The components, whether administered separately or together are employed in pharmaceutically acceptable carriers such as conventional vehicles adapted for oral adminstration such as capsules, tablets, or liquid solutions or suspensions. The components separately or together, can also be dissolved in a vehicle adapted for administration by injection. Suitable formulations for oral use, may include diluents, granulating agents, preservatives, binders, flavoring agents, and coating agents. The example of an oral use composition in the combination of active ingredients, or the acid component alone, intermixed in the dry pulverulent state with gelatin, starch, magnesium stearate, and alginic acid, and pressed into a tablet.
As noted above, the presently known preferred method is parenteral administration of the antibiotic and either co-parenteral administration or oral administration of the propenoate compound.